Loss of insight and functional neuroimaging in frontotemporal dementia

Loss of insight is a diagnostic criterion for frontotemporal dementia. It is associated with hypoperfusion/hypometabolism in the right hemisphere, particularly the frontal lobe. Loss of insight is often an anosodiaphoria (i.e., lack of concern) rather than an anosognosia (i.e., decreased awareness).     

Are Varicose Veins a Marker for Susceptibility to Coronary Heart Disease in Men? Results from the Normative Aging Study

Clinical observations suggest that varicose veins (VV) are less frequent in patients undergoing infrainguinal bypass surgery for femoral artery occlusive disease. While some previous studies support this relationship, others report that VV are more prevalent in coronary heart disease patients (CHD). This study used the Normative Aging Study (NAS) population to examine the association between VV and symptomatic CHD. The incidence of CHD over 35 years of follow-up was determined in the 2280 initially healthy male volunteers enrolled in the NAS. The incidence of CHD in the VV population and the subjects without VV were compared using Kaplan-Meier survival curves and the log-rank test. A time-dependent proportional hazards regression method was used to further explore the relationship between VV disease and subsequent development of CHD after adjusting for other cardiovascular risk factors. A total of 569 subjects (24.9%) were diagnosed with VV prior to the development of symptomatic CHD, and 1708 (75.1%) were not. Over 35 years of follow-up, 98 subjects with VV developed symptomatic CHD (17.2%), while 363 of those without VV subsequently developed symptomatic CHD (21.2%). Kaplan-Meier survival curves suggested a reduced risk of symptomatic CHD for subjects with VV (p = 0.0001). Further exploration of this relationship in a proportional hazards multivariate model showed VV to be associated with a 36% decreased risk of symptomatic CHD after adjusting for other recognized cardiovascular risk factors. In the NAS population, men with VV were less likely to develop symptomatic CHD over the 35+ years of follow-up than were subjects without VV.     

Stabilization clamp for insertion of deep brain stimulation electrodes: technical note

BACKGROUND: Deep brain stimulation (DBS) electrodes are being implanted with increasing frequency for the management of movement disorders and chronic pain. Success with this neuro-augmentative technique requires accurate electrode lead placement. In order to enhance accuracy of final lead placement and ease of insertion, we describe a useful and reliable DBS electrode lead stabilization device developed and used at our centre. MATERIALS AND METHODS: The DBS electrode stabilization device consists of a 2-clamp system designed to fit the Leksell stereotactic frame. The clamps work in series to secure the stereotactic lead at the time of its final positioning in the desired subcortical target without the need of fluoroscopic control. RESULTS: The DBS electrode stabilization device has been used in 30 patients for 54 electrode implantations at our institution since 2000. Postoperative magnetic resonance imaging was performed in all cases and confirmed accurate placement of the electrodes. CONCLUSIONS: Accurate electrode lead placement is critical for the clinical efficacy of DBS systems. The simple and reliable stabilization device described here is easy to operate and enhances the final placement accuracy of DBS electrode leads.     

Acute lung injury after blood transfusion in mechanically ventilated patients

BACKGROUND: Liberal transfusion strategy increases the risk of acute lung injury (ALI), but specific transfusion-related factors have not been characterized. We tested the hypotheses that storage age and specific type of blood products are associated with increased risk of ALI in mechanically ventilated patients. STUDY DESIGN AND METHODS: From a database of mechanically ventilated patients, we identified those who received blood products during the first 48 hours of intensive care. We extracted information about underlying ALI risk factors as well as the type, amount, and shelf age of administered blood products. Outcome was assessed by an independent, blind review of chest radiographs and clinical findings. RESULTS: Of 181 patients transfused during the first 48 hours of mechanical ventilation, 60 (33%) developed ALI. There was no difference in average duration of red blood cells storage between patients who did and did not develop ALI (median, 18.5 vs. 17.5 days; p = 0.22). In a multivariable logistic regression analysis, important risk factors associated with the development of ALI were thrombocytopenia (odds ratio, 5.9; p = 0.004) and transfusion of fresh frozen plasma (odds ratio, 3.2; p = 0.023). CONCLUSION: Thrombocytopenia and transfusion of fresh frozen plasma, but not storage age of red blood cells, were associated with the development of ALI in this cohort of mechanically ventilated patients.     

Combined spatial, contrast, and temporal functions perimetry in mild glaucoma and ocular hypertension

PURPOSE: To evaluate the diagnostic ability of a new perimetric procedure in glaucoma. METHODS: Pulsar perimeter shows white circular sinusoidal grating patterns with decreasing amplitude, 5 degrees in diameter, 500 msec in duration in 66 locations. The stimuli scale combines spatial resolution and contrast. The stimuli were shown with centrifugal wave motion at 8 cyl/deg (K6W) or pulse at 30 Hz (T30W). Fifty-six normal eyes and 82 eyes with ocular hypertension and mild glaucoma were included. These 82 cases were classified into four levels of diagnostic certainty, from 0 (ocular hypertension) to 3 (mild glaucoma). RESULTS: Mean examination time was 3:49 min. Specificity was 96.4% (T30W) and 94.6% (K6W). Sensitivities for levels 0 and 3 were 34.5% to 100% (T30W) and 24.1 % to 75% (K6W). The receiver operating characteristic (ROC) curve areas for T30W at levels 1, 2, and 3 were 0.88, 0.94, and 0.99. The ROC areas for K6W were 0.83, 0.91, and 0.97. There was good correlation between both Pulsar perimetries (r=0.88), but it was lower with conventional perimetry (r=0.58 for T30W and r=0.59 for K6W). CONCLUSIONS: The novel Pulsar T30W perimetry may be helpful for the study of mild glaucoma and ocular hypertension.     

Intraspinal transplantation of hNT neurons in the lesioned adult rat spinal cord

BACKGROUND: The role of neural transplantation as a restorative strategy for spinal cord injury continues to be intensely investigated. Ideally, the tissue source for transplantation must be readily available, free of disease and able to survive and mature following implantation into the adverse environment created by the injury. We have studied the use of a commercially available cell line of cultured human neurons (hNT neurons) as a tissue source for neural transplantation in spinal cord injury. METHODS: Following a left lateral thoracic hemisection, 54 immunosuppressed, female Wistar rats were randomly allocated into different treatment groups; hemisection only or hemisection and hNT cell transplantation (via a bridge, double or triple graft). Grafting occurred three days after spinal cord injury. After thirteen weeks the animals were sacrificed and tissue sections were stained with human neuron specific enolase and human specific neural cell adhesion molecule. RESULTS: Immunohistochemical evidence of graft survival was displayed in 66.7% of the surviving, grafted animals. Fibre outgrowth, greatest in the bridge and triple grafts, was observed in both rostral and caudal directions essentially bridging the lesion. Double grafts were smaller, displaying less fibre outgrowth, which did not cross the lesion. Long fibre outgrowth was evident up to 2 cm from the graft as assessed by tracing and immunohistochemical studies. CONCLUSIONS: Bridge and triple grafts displayed greater growth and enabled the hNT graft to essentially bridge the lesion. This suggests that hNT neurons have the potential to structurally reconnect the proximal and distal spinal cord across the region of injury.     

Hypersexuality after right pallidotomy for Parkinson's disease

The authors describe hypersexuality following atypical right pallidotomy for intractable Parkinson's Disease (PD). This patient and literature review suggest important roles for the pallidum in sexual behavior and dopamine in sexual arousal.     

Alterations of the sense of "humanness" in right hemisphere predominant frontotemporal dementia patients.

OBJECTIVE: To evaluate the sense of "humanness" in frontotemporal dementia (FTD) patients with right hemispheric involvement. BACKGROUND: Early in the course, FTD is often asymmetric, and those with predominant right frontotemporal disease have disproportionate disturbances in social behavior and empathy. A disruption in a sense of humanness may underlie these behavioral disturbances. METHOD: Sixteen patients with asymmetric FTD on functional neuroimaging underwent recognition tests of facial masking, human-animal morphing, and facial distortion. Additional tests evaluated facial discrimination and the recognition of famous faces, facial emotions, and animate-inanimate differences. RESULTS: On the distorted and morphed face tasks, 8 FTD patients with predominant right hemisphere involvement were significantly more likely to call morphed and distorted faces "human" as compared with both 8 FTD patients with predominant left hemisphere involvement and normal controls. The FTD groups did not differ on thresholds for recognizing masked faces or on other face recognition measures. CONCLUSIONS: In FTD, right hemispheric involvement may alter the threshold for judging someone as human independent of the recognition of faces or facial affect. These results suggest that a specific sense of humanness facilitates a person recognition network in the right frontotemporal region of the brain.